多层螺旋CT血管三维重建在脑膜瘤术前评估的应用价值
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摘要
目的:研究多层螺旋CT血管三维重建在脑膜瘤术前评估的应用价值。材料和方法:收集2007-2008年术前诊断脑膜瘤并住院经手术治疗和病理证实的患者42例。其中男性患者18例,女性患者24例;年龄在32-65岁,平均年龄41.8岁。应用我院GE公司生产的64排螺旋CT均在术前一周内行头颅3D-CTA检查;在Sun独立工作站,应用GE公司AW4.0,以SSD,MIP,MPR ,VR法完成图像后处理,重点了解脑膜瘤的血供、肿瘤与周围大血管的关系,肿瘤对颅骨的侵犯情况。图像以多角度旋转的录像和静态胶片输出形式保存。同时行头颅MRI检查,并与3D-CTA进行比较。术前手术医师根据影像学图像设计手术入,模拟手术过程。结果:1、术前定位诊断和MRI结果相同,诊断正确率100%。定性诊断3例与术后病理诊断不符,MRI有2例不符;二者的检验效能行X2检验,X2=0.004,P>0.05;二者之间无差异。2、肿瘤血供:单纯颈外动脉供血22例,单纯颈内动脉供血10例,颈内颈外混合供血11例。3、肿瘤与周围大血管的关系:术前发现肿瘤侵蚀大血管12例,术中见肿瘤与血管粘连严重,肿瘤无法与血管分离。术前发现肿瘤推挤大血管30例,术中可将血管从肿瘤上分离。术前了解肿瘤与周围血管的关系,可以帮助制定手术方案。4、静脉窦显示:本组8例窦镰旁脑膜瘤术前行3D-CTV检查,均能清楚显示静脉窦的通畅程度以及肿瘤是否侵犯静脉窦。1例矢状窦后1/3脑膜瘤术前显示矢状窦闭塞,周围引流静脉代偿性扩张,术中所见与术前检查所见相符,采取相应措施,术后病人恢复良好。5、显示脑膜瘤对颅骨的侵蚀程度:本组病人显示颅骨侵犯9例,与术中所见吻合。6例颅底脑膜瘤患者根据3D-CTA提示信息,术前模拟手术入路,行肿瘤全切或大部切除,术后患者恢复良好。结论:3D-CTA是一种新兴的检查手段,能够清晰、准确地显示肿瘤的立体结构、供血动脉、引流静脉、周围大血管以及静脉窦和颅骨之间的三维立体关系,术前进行手术入路的选择和颅骨瓣的设计,为脑膜瘤的手术治疗提供科学、直观、翔实的影像学资料,增加手术的安全性。3D-CTA是脑膜瘤术前评估非常有价值的影像学检查方法。
Objective : Discuss value of multislice spiral three-dimensional computer tomography angiography in preoperative evaluation of meningioma. Materials and Method: Forty two patients(male 18, female 24) with meningiomas were examined with preoperative 3D-CTA. They were examined within one week before operation , MRI were examined too in order to compare with 3D-CT.The technique of volume rendering (VR), multiplanner reconstraction (MPR), shade surface display(SSD) ,max intensity projection (MIP),were used to reconstruct the 3D images in all cases and simulate the approach of operation.Result:1、3D-CTA shared the same preoperative diagnostic accuracy to MRI(P>0.05).2、3D-CTA showed the main vessels of the meningiomas clearly and precisely.3、3D-CTA clearly displayed the 3D spatial relationship between the lesions and neighboring vascular.4、3D-CTA could disclose the main venous sinus with accuracy.5、3D-CTA showed the degree of skulls’erosion clearly.6、3D-CTA simulated the approach of operation, make the operation in security. Conclusion:Multislice spiral three-dimensional computer tomography angiography not only demonstrated the tumor’s size, main vessel, but also lesions, neighboring vascular and skull structures clearly, directly and spatially. Three-dimensional computer tomography angiography could simulated the approach of operation, and make the operation in security. So that, multislice spiral three-dimensional computer tomography angiography is an important target in preoperative evaluation of meningioma.
Objective : Discuss value of multislice spiral three-dimensional computer tomography angiography in preoperative evaluation of meningioma. Materials and Method: Forty two patients(male 18, female 24) with meningiomas were examined with preoperative 3D-CTA. They were examined within one week before operation , MRI were examined too in order to compare with 3D-CT.The technique of volume rendering (VR), multiplanner reconstraction (MPR), shade surface display(SSD) ,max intensity projection (MIP),were used to reconstruct the 3D images in all cases and simulate the approach of operation.Result:1、3D-CTA shared the same preoperative diagnostic accuracy to MRI(P>0.05).2、3D-CTA showed the main vessels of the meningiomas clearly and precisely.3、3D-CTA clearly displayed the 3D spatial relationship between the lesions and neighboring vascular.4、3D-CTA could disclose the main venous sinus with accuracy.5、3D-CTA showed the degree of skulls’erosion clearly.6、3D-CTA simulated the approach of operation, make the operation in security. Conclusion:Multislice spiral three-dimensional computer tomography angiography not only demonstrated the tumor’s size, main vessel, but also lesions, neighboring vascular and skull structures clearly, directly and spatially. Three-dimensional computer tomography angiography could simulated the approach of operation, and make the operation in security. So that, multislice spiral three-dimensional computer tomography angiography is an important target in preoperative evaluation of meningioma.
引文
1王忠诚神经外科学/王忠诚主编.—武汉:湖北科学技术出版社,005.3:501-589
2于明涛,唐东生.64层CT技术及发展趋势[J].医疗卫生装备, 2005,26(4):21-22.
3张飞雪,王青,杨晨明,等.16层螺旋CT血管造影技术在颅内疾病诊断中的临床应用[J].医学影像杂志,2004,14(12):963-966.
4张雷莉,崔世民,刘梅力,等.螺旋CT血管造影对颅内脑膜瘤诊的应用[J].天津医药,2002,30(4):218-219.
5胡春峰,李江山,李绍东,等.颅底脑膜瘤双期多排螺旋CT血管造影的临床应用[J].CT理论与应用研究,2006,15(1):6-10.
6陈浪,周义成,张进华,等.多层螺旋CT脑血管造影的优势[J].中国医学影像技术,2005,21(2):261-264.
7 Health DG,Soyer PA,Kuszyk BS,et a1.Three-dimensional spiral CT during arterial portography:comparison of three rendering techniques[J].Radiographics,1995,15(4):1001-1011.
8 Takahashi M,Ashtari M,Papp Z,et a1.CT angiography of carotid bifurcation:artifacts and pitfalls in shaded-surface display[J].AJR Am J Roentgenol,1997,168(3):813-817.
9 Nino-Murcia M,Jeffrey RB,Beaulieu CF,et a1.Multidetector CT of the pancreas and bile duct system:value of curved planar reformations[J].AJR Am J Roentgenol,2001,176(3):689-693.
10 Rubin GD.Data explosion:the challenge of multidetector—row CT[J].Eur J Radiol,2000,36(2):74-80.
11 Korogi Y, Takahashi M,Katada K,et al.Intracranial Aneurysms:Detection with Three-dimensional CT Angiography with Volume Rendering-Comparison with Conventional Angiographic and Surgical Findings.Radiology,1999,211:497-506.
12 Villablaca JP,Martin N,Jahan R,et al.Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms.J Neurosurg,2000,93(8):254-264.
13 Alvemia JE.Sindou MP.Preoperative neuroimaging findings as a predictor of the surgical plane of clearage:prospective study of 100 consecutive cases of intracranial meningioma[J].Neurosurgery,2004,100(3):422-430.
14 Hashimoto H,Lida J,Hironaka Y, et al. Wall imaging of cerebral aneurysm with a modified surface-rendering technique of spiral CT.Acta neurochir(Wien).2000,142(9):1003-1012.
15 Manelfe C,Lasjaunias P,Ruscalleda J.Preoperative embolization of intracranial meningiomas[J]. AJNR Am J Neuroradiol1986,7(5):963-972.
16 Otawara Y,Ogasawara K,Ogawa A,et a1.Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiagaphy[J]. Neurosurgery,2002,51(4):939-942.
17 Hu H,He HD,Fox SH.Four multidetector-row helical CT:mage quality and volume coverage speed[J].Radiology,2000,2 1(1):55-62.
18 Jones TR,Kaplan RT,Atlas SW,et a1.Single-versus multi-detector row CT of the brain:quality assessment[J]. Radiology,2001,219(3):750-755.
19 Tsuchiya K,Hachiya J,Mizutani Y,et al.Three-dimensional.helical CT angiography of skull base meningiomas[J].Neuroradiol,1996,17(5):933-936.
20王志铭,牛玉军,雷振,等.螺旋CT血管成像(SCTA)诊断脑膜瘤临床价值[J].中国临床医学影像杂志,2002,13(2): 80-82.
21韩向君,王廷昱,高惠,等.多层螺旋CT血管成像三维重建对脑膜瘤血供的评价及应用[J].中国介入影像与治疗学,2006,3(3):172-174.
22 Tsuchiya K,Katase S,Yoshino A,et a1.MR digital subtraction angiography in the diagnosis of meningiomas[J].Eur J Radiol,2003,46(2):130-138.
23夏雷,陈坚. CT血管造影对脑膜瘤侵蚀颅内血管的术前评价[J].实用医学杂志,2005,21(8):800-802.
25 Russell DS,Rubinstein LJ. Pathology of tumours of the nervoussystem[M]. 5 th ed. Baltimore:Williams & Wilkiss,1989:331.
26 Weltzel SG,Kirsch E,Stock KW,et a1.Cerebral veins:comparative study of CT venagraphy with intraarlerial digital subtraction angiography[J]. AJNR Am J Neuroradiol,1999,20(2):249-255.
27于如同,李祥,潘昕,等.脑膜瘤患者三维CT血管造影的临床意义[J].中华神经外科杂志,2005,21(9):562-563.
28胡锦清,沈健康,张仲伟,等.三维CT血管造影在神经外科术前评估中的初步应用经验[J].中国神经精神疾病杂志,1999,1(1):27-30.
29 Matsumoto M,Kodama N,Sakuma J,et al. 3D-CT arteriography and 3D-CT venography:the separate demonstration of arterial-phase and venous-phase on 3D-CT angiography in a single procedure[J]. AJNR Am J Neuroradiol,2005,26(3):635-641.
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32姜保东,冯晓源,李克,等.脑CT静脉成像技术及临床应用[J].中国医学计算机成像杂志,2005,11(5):295-299.
33 Klein HM,Bertalanffy H,Mayfank L,et a1.Three-dimensional spiral CT for neurosurgieal planning[J]. Neuroradiology,1994,36(5):435-439.
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37 Hope JK,Wilson JL,Thomson FJ.Three-dimensional CT angiography in the detection and characterization of intracranial berry aneurysms.[J] AJNR Am J Neuroradiol,1996,17:437-455
38 Korogi Y,Takahashi M,Katada K,et al.Intracranial aneurysms: detection with Three-dimensional CT angiography with Volume-Rendering-Comparison with Conventional Angiographic and surgical findings.Radiology,1999,211:497-506.
39 Vieco PT,Morin EE 3rd,Gross CE.CT angiography in the examination of patients with aneurysm clips. AJNR Am J Neuroradiol,1996,17(3):455-457.
40 Schmid-Elsaesser R,Muacevic A,Holtmannspotter M,et al.Neuronavigation based on CT angiography for surgery ofintracranial aneurysm:primary experience with unruptured aneurysms.Minim Invasive Neurosurgery,2003,46(5):269-277
41 AlbericoRA,Barnes P ,Robertson RL, et al .Helical CT Angiography:Dynamic cerebrovascular imaging in children.A JNR Am Neuroradiol,1999, 20 (2):328-334
42柏沙美,江新青,谢琦,等.16层螺旋CT血管造影在颅内病变中的应用[J].中国中西医结合影像学杂志,2005,4(6):418-420.
43邝昆琦,陈坚,张菁.三维CT血管造影对颅内肿瘤外科诊治价值[J].医师进修杂志(外科版),2005,27(8):21-23.
1于明涛,唐东生.64层CT技术及发展趋势[J].医疗卫生装备, 2005,26(4):21-22.
2张飞雪,王青,杨晨明,等.16层螺旋CT血管造影技术在颅内疾病诊断中的临床应用[J].医学影像杂志,2004,14(12):963-966.
3张雷莉,崔世民,刘梅力,等.螺旋CT血管造影对颅内脑膜瘤诊断的应用[J].天津医药,2002,30(4):218-219.
4胡春峰,李江山,李绍东,等.颅底脑膜瘤双期多排螺旋CT血管造影的临床应用[J].CT理论与应用研究,2006,15(1):6-10.
5陈浪,周义成,张进华,等.多层螺旋CT脑血管造影的优势[J].中国医学影像技术,2005,21(2):261-264.
6 Health DG,Soyer PA,Kuszyk BS,et a1.Three-dimensional spiral CT uring arterial portography:comparison of three rendering techniques[J].Radiographics,1995,15(4):1001-1011.
7 Takahashi M,Ashtari M,Papp Z,et a1.CT angiography of carotid bifurcation:artifacts and pitfalls in shaded-surface display[J].AJR Am J Roentgenol,1997,168(3):813-817.
8 Nino-Murcia M,Jeffrey RB,Beaulieu CF,et a1.Multidetector CT of the pancreas and bile duct system:value of curved planar reformations[J].AJR Am J Roentgenol,2001,176(3):689-693.
9 Rubin GD.Data explosion:the challenge of multidetector—row CT[J].Eur J Radiol,2000,36(2):74-80.
10 Alvemia JE.Sindou MP.Preoperative neuroimaging findings as a predictor of the surgical plane of clearage:prospective study of 100 consecutive cases of intracranial meningioma[J].Neurosurgery,2004,100(3):422-430.
11 Manelfe C,Lasjaunias P,Ruscalleda J.Preoperative embolization of intracranial meningiomas[J]. AJNR Am J Neuroradiol1986,7(5):963-972.
12 Otawara Y,Ogasawara K,Ogawa A,et a1.Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiagaphy[J]. Neurosurgery,2002,51(4):939-942.
13 Prokop M.Multislice CT angiography[J]. Ear J Radiol,2000,36(2):86-96.
14 Hu H,He HD,Fox SH.Four multidetector-row helical CT:mage quality and volume coverage speed[J].Radiology,2000,2 1(1):55-62.
15 Jones TR,Kaplan RT,Atlas SW,et a1.Single-versus multi-detector row CT of the brain:quality assessment[J]. Radiology,2001,219(3):750-755.
16 Tsuchiya K,Hachiya J,Mizutani Y,et al.Three-dimensional.helical CT angiography of skull base meningiomas[J].Neuroradiol,1996,17(5):933-936.
17王志铭,牛玉军,雷振,等.螺旋CT血管成像(SCTA)诊断脑膜瘤临床价值[J].中国临床医学影像杂志,2002,13(2): 80-82.
18韩向君,王廷昱,高惠,等.多层螺旋CT血管成像三维重建对脑膜瘤血供的评价及应用[J].中国介入影像与治疗学,2006,3(3):172-174.
19 Tsuchiya K,Katase S,Yoshino A,et a1.MR digital subtraction angiography in the diagnosis of meningiomas[J].Eur J Radiol,2003,46(2):130-138.
20夏雷,陈坚. CT血管造影对脑膜瘤侵蚀颅内血管的术前评价[J].实用医学杂志,2005,21(8):800-802.
21 Russell DS,Rubinstein LJ. Pathology of tumours of the nervous system[M]. 5 th ed. Baltimore:Williams & Wilkiss,1989:331.
22 Weltzel SG,Kirsch E,Stock KW,et a1.Cerebral veins:comparative study of CT venagraphy with intraarlerial digital subtraction angiography[J]. AJNR Am J Neuroradiol,1999,20(2):249-255.
23 Ozsvath RR,Casey SO,Lustrin ES,et a1.Cerebral venography:comparision of CT and MR projection venography MR[J]. AJR Am J Roentgenol,1997,169(6):1699-1707.
24如同,李祥,潘昕,等.脑膜瘤患者三维CT血管造影的临床意义[J].中华神经外科杂志,2005,21(9):562-563.
25胡锦清,沈健康,张仲伟,等.三维CT血管造影在神经外科术前评估中的初步应用经验[J].中国神经精神疾病杂志,1999,1(1):27-30.
26 Matsumoto M,Kodama N,Sakuma J,et al. 3D-CT arteriography and3D-CT venography:the separate demonstration of arterial-phase and venous-phase on 3D-CT angiography in a single procedure[J]. AJNR Am J Neuroradiol,2005,26(3):635-641.
27姜保东,冯晓源,李克,等.脑CT静脉成像技术及临床应用[J].中国医学计算机成像杂志,2005,11(5):295-299.
28 Klein HM,Bertalanffy H,Mayfank L,et a1.Three-dimensional spiral CT for neurosurgieal planning[J]. Neuroradiology,1994,36(5):435-439.
29柏沙美,江新青,谢琦,等.16层螺旋CT血管造影在颅内病变中的应用[J].中国中西医结合影像学杂志,2005,4(6):418-420.
30邝昆琦,陈坚,张菁.三维CT血管造影对颅内肿瘤外科诊治价值[J].医师进修杂志(外科版),2005,27(8):21-23.
2于明涛,唐东生.64层CT技术及发展趋势[J].医疗卫生装备, 2005,26(4):21-22.
3张飞雪,王青,杨晨明,等.16层螺旋CT血管造影技术在颅内疾病诊断中的临床应用[J].医学影像杂志,2004,14(12):963-966.
4张雷莉,崔世民,刘梅力,等.螺旋CT血管造影对颅内脑膜瘤诊的应用[J].天津医药,2002,30(4):218-219.
5胡春峰,李江山,李绍东,等.颅底脑膜瘤双期多排螺旋CT血管造影的临床应用[J].CT理论与应用研究,2006,15(1):6-10.
6陈浪,周义成,张进华,等.多层螺旋CT脑血管造影的优势[J].中国医学影像技术,2005,21(2):261-264.
7 Health DG,Soyer PA,Kuszyk BS,et a1.Three-dimensional spiral CT during arterial portography:comparison of three rendering techniques[J].Radiographics,1995,15(4):1001-1011.
8 Takahashi M,Ashtari M,Papp Z,et a1.CT angiography of carotid bifurcation:artifacts and pitfalls in shaded-surface display[J].AJR Am J Roentgenol,1997,168(3):813-817.
9 Nino-Murcia M,Jeffrey RB,Beaulieu CF,et a1.Multidetector CT of the pancreas and bile duct system:value of curved planar reformations[J].AJR Am J Roentgenol,2001,176(3):689-693.
10 Rubin GD.Data explosion:the challenge of multidetector—row CT[J].Eur J Radiol,2000,36(2):74-80.
11 Korogi Y, Takahashi M,Katada K,et al.Intracranial Aneurysms:Detection with Three-dimensional CT Angiography with Volume Rendering-Comparison with Conventional Angiographic and Surgical Findings.Radiology,1999,211:497-506.
12 Villablaca JP,Martin N,Jahan R,et al.Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms.J Neurosurg,2000,93(8):254-264.
13 Alvemia JE.Sindou MP.Preoperative neuroimaging findings as a predictor of the surgical plane of clearage:prospective study of 100 consecutive cases of intracranial meningioma[J].Neurosurgery,2004,100(3):422-430.
14 Hashimoto H,Lida J,Hironaka Y, et al. Wall imaging of cerebral aneurysm with a modified surface-rendering technique of spiral CT.Acta neurochir(Wien).2000,142(9):1003-1012.
15 Manelfe C,Lasjaunias P,Ruscalleda J.Preoperative embolization of intracranial meningiomas[J]. AJNR Am J Neuroradiol1986,7(5):963-972.
16 Otawara Y,Ogasawara K,Ogawa A,et a1.Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiagaphy[J]. Neurosurgery,2002,51(4):939-942.
17 Hu H,He HD,Fox SH.Four multidetector-row helical CT:mage quality and volume coverage speed[J].Radiology,2000,2 1(1):55-62.
18 Jones TR,Kaplan RT,Atlas SW,et a1.Single-versus multi-detector row CT of the brain:quality assessment[J]. Radiology,2001,219(3):750-755.
19 Tsuchiya K,Hachiya J,Mizutani Y,et al.Three-dimensional.helical CT angiography of skull base meningiomas[J].Neuroradiol,1996,17(5):933-936.
20王志铭,牛玉军,雷振,等.螺旋CT血管成像(SCTA)诊断脑膜瘤临床价值[J].中国临床医学影像杂志,2002,13(2): 80-82.
21韩向君,王廷昱,高惠,等.多层螺旋CT血管成像三维重建对脑膜瘤血供的评价及应用[J].中国介入影像与治疗学,2006,3(3):172-174.
22 Tsuchiya K,Katase S,Yoshino A,et a1.MR digital subtraction angiography in the diagnosis of meningiomas[J].Eur J Radiol,2003,46(2):130-138.
23夏雷,陈坚. CT血管造影对脑膜瘤侵蚀颅内血管的术前评价[J].实用医学杂志,2005,21(8):800-802.
25 Russell DS,Rubinstein LJ. Pathology of tumours of the nervoussystem[M]. 5 th ed. Baltimore:Williams & Wilkiss,1989:331.
26 Weltzel SG,Kirsch E,Stock KW,et a1.Cerebral veins:comparative study of CT venagraphy with intraarlerial digital subtraction angiography[J]. AJNR Am J Neuroradiol,1999,20(2):249-255.
27于如同,李祥,潘昕,等.脑膜瘤患者三维CT血管造影的临床意义[J].中华神经外科杂志,2005,21(9):562-563.
28胡锦清,沈健康,张仲伟,等.三维CT血管造影在神经外科术前评估中的初步应用经验[J].中国神经精神疾病杂志,1999,1(1):27-30.
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